Method and system for detecting electrophysiological changes in pre-cancerous and cancerous tissue

ABSTRACT

Methods and systems are provided for determining a condition of a selected region of epithelial tissue and/or an organ in a body as well as to diagnose disease, susceptibility, premalignancy or cancer and to measure response to therapy, introduction of a drug and to assess the margins of a tumor or resection. The methods utilize through the tissue or organ electrical measurements with alternating current applied using one or more surface or internal electrodes and measuring the electrical response using one or more surface electrodes, preferably in combination with one or more electrodes in direct or indirect contact with epithelium comprising the organ or tissue under test. The methods are also useful in combination with DC measurements on the surface of the organ or tissue under test. Measurement of impedance, admittance, electropotential and dielectric properties is particularly useful, particularly as a function of frequency and position on and in the tissue or organ.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation-in-part of U.S. patent applicationSer. No. 11/096,665, filed Apr. 1, 2005, which is a divisional of Ser.No. 10/151,233, filed May 20, 2002, the latter now U.S. Pat. No.6,922,586, granted Jul. 26, 2005; the disclosures of the above mentionedapplication and granted patent are hereby incorporated by referenceherein.

BACKGROUND OF INVENTION

The present invention relates generally to the detection of abnormal orcancerous tissue and, more particularly, to the detection of changes inelectrophysiological characteristics of abnormal or cancerous tissuerelated to the functional, structural, and topographic relationships ofthe tissue during the development of malignancy. These measurements maybe made in the absence and/or presence of pharmacological or hormonalagents to reveal and accentuate electrophysiological characteristicsindicative of abnormal or cancerous tissue.

Cancer is a leading cause of death in both men and women in the UnitedStates. Difficulty in detecting abnormal pre-cancerous or canceroustissue before treatment options become non-viable is one reason for thehigh mortality rate. Detecting the presence of abnormal or canceroustissues is difficult, in part, because such tissues are largely locateddeep within the body, thus requiring expensive, complex, invasive,and/or uncomfortable procedures. For this reason, the use of detectionprocedures is often restricted until a patient is experiencing symptomsrelated to the abnormal tissue. Many forms of cancers or tumors,however, require extended periods of time to attain a detectable size(and thus to produce significant symptoms or signs in the patient). Itis often too late for effective treatment by the time the cancer ortumor is detected using currently available diagnostic modalities.

One proposed method for early detection of cancerous and pre-canceroustissue includes measuring of the electrical impedance of biologicaltissue. For example, U.S. Pat. No. 3,949,736 discloses a low-levelelectric current passed through tissue, with a measurement of thevoltage drop across the tissue providing an indirect indication of theoverall tissue impedance. This method teaches that a change in impedanceof the tissue is associated with an abnormal condition of the cellscomposing the tissue, indicating a tumor, carcinoma, or other abnormalbiological condition. This disclosure, however, does not discuss eitheran increase or decrease in impedance associated with abnormal cells, nordoes it specifically address tumor cells.

One disadvantage of this and similar systems is that the inherent DCelectrical properties of the epithelium are not considered. Many commonmalignancies develop in an epithelium, often the cell layer that lines ahollow organ, such as the bowel, or in ductal structures, such as thebreast or prostate. Epithelial tissue maintains a transepithelialelectropotential (TEP) that may be altered by the malignancy process.Early in the malignant process, the epithelium may lose itstransepithelial potential, particularly when compared to epithelium somedistance away from the developing malignancy. Thus, the combination oftransepithelial electropotential measurements with impedance may be moreaccurate in diagnosing pre-cancerous and cancerous conditions.

Another disadvantage of the above referenced system is that thefrequency range is not defined. Certain information may be obtainedabout cells according to the range of frequencies selected. Differentfrequency bands may be associated with different structural orfunctional aspects of the tissue. See, for example, F. A. Duck, PhysicalProperties of Tissues, London: Academic Press, 2001; K. R. Foster, H. P.Schwan, Dielectric properties of tissues and biological materials: acritical review, Crit. Rev. Biomed. Eng., 1989, 17(1): 25-104. Forexample at high frequencies, such as >1 GHz, molecular structure has adominating effect on the relaxation characteristics of the impedanceprofile. Relaxation characteristics include the delay in response of atissue to a change in the applied electric field. For example, anapplied AC current results in a voltage change across the tissue whichwill be delayed, or phase shifted, because of the impedancecharacteristics of the tissue. Relaxation and dispersion characteristicsof tissue vary according to the frequency of the applied signal.

At lower frequencies, such as <100 Hz, or the so called α-dispersionrange, alterations in ion transport and charge accumulations at largecell membrane interfaces dominate the relaxation characteristics of theimpedance profile. In the frequency range between a few kHz and 1 MHz,or the so-called β-dispersion range, cell structure dominates therelaxation characteristics of the epithelial impedance profile. Withinthis range at low kHz frequencies, most of the applied current passesbetween the cells through the paracellular pathway and tight junctions.At higher frequencies in the β-dispersion range the current canpenetrate the cell membrane and therefore passes both between andthrough the cells, and the current density will depend on thecomposition and volume of the cytoplasm and cell nucleus.

Characteristic alterations occur in the ion transport of an epitheliumduring the process of malignant transformation affecting the impedancecharacteristics of the epithelium measured at frequencies in theα-dispersion range. Later in the malignant process, structuralalterations with opening of the tight junctions and decreasingresistance of the paracellular pathways, together with changes in thecomposition and volume of the cell cytoplasm and nucleus, affect theimpedance measured in the β-dispersion range.

Another disadvantage of the above referenced system is that thetopography of altered impedance is not examined. By spacing themeasuring electrodes differently, the epithelium can be probed todifferent depths. The depth that is measured by two surface electrodesis approximately half the distance between the electrodes. Therefore,electrodes 1 mm apart will measure the impedance of the underlyingepithelium to a depth of approximately 500 microns. It is known, forexample, that the thickness of bowel epithelium increases at the edge ofa developing tumor to 1356±208μ compared with 716±112μ in normal bowel.D. Kristt, et al. Patterns of proliferative changes in crypts borderingcolonic tumors: zonal histology and cell cycle marker expression.Pathol. Oncol. Res 1999; 5(4): 297-303. By comparing the measuredimpedance between electrodes spaced approximately 2.8 mm apart with theimpedance of electrodes spaced approximately 1.4 mm apart, informationabout the deeper and thickened epithelium may be obtained. See, forexample, L. Emtestam & S. Ollmar. Electrical impedance index in humanskin: measurements after occlusion, in 5 anatomical regions and in mildirritant contact dermatitis. Contact Dermatitis 1993; 28(2): 104-108.

Another disadvantage of the above referenced methods is that they do notprobe the specific conductive pathways that are altered during themalignant process. For example, potassium conductance is reduced in thesurface epithelium of the colon early in the malignant process.

Other patents, such as U.S. Pat. Nos. 4,955,383 and 5,099,844, disclosethat surface electropotential measurements may be used to diagnosecancer. Empirical measurements, however, are difficult to interpret anduse in diagnosis. For example, the above referenced inventions diagnosecancer by measuring voltage differences (differentials) between oneregion of the breast and another and then comparing them withmeasurements in the opposite breast. Changes in the measured surfacepotential may be related to differences in the impedance characteristicsof the overlying skin. This fact is ignored by the above referenced andsimilar inventions, resulting in a diagnostic accuracy of 72% or less.J. Cuzick et al. Electropotential measurements as a new diagnosticmodality for breast cancer. Lancet 1998; 352(9125): 359-363; M. Faupelet al. Electropotential evaluation as a new technique for diagnosingbreast lesions. Eur. J. Radiol. 1997; 24 (1): 33-38.

Other inventions that use AC measurement, such as U.S. Pat. No.6,308,097, also have a lower accuracy than may be possible with acombination of DC potential measurements and AC impedance measurements.The above referenced system diagnoses cancer by only measuring decreasedimpedance (increased conductance) over a cancer.

Another potential source of information for the detection of abnormaltissue is the measurement of transport alterations in the mucosa.Epithelial cells line the surfaces of the body and act as a barrier toisolate the body from the outside world. Not only do epithelial cellsserve to insulate the body, but they also modify the body's environmentby transporting salts, nutrients, and water across the cell barrierwhile maintaining their own cytoplasmic environment within fairly narrowlimits. One mechanism by which the epithelial layer withstands theconstant battering is by continuous proliferation and replacement of thebarrier. This continued cell proliferation may partly explain why morethan 80% of cancers are of epithelial cell origin.

It is known that the addition of serum to quiescent fibroblasts resultsin rapid cell membrane depolarization. Cell membrane depolarization isan early event that may be associated with cell division. Depolarizationinduced by growth factors appears biphasic in some instances, but celldivision may be stimulated without depolarization. Cell membranedepolarization is temporally associated with Na⁺ influx, and the influxpersists after repolarization has occurred. Although the initial Na⁺influx may result in depolarization, the increase in sodium transportmay not cease once the cell membrane has been repolarized, possibly dueto Na/K ATPase pump activation. Other studies also support that Na⁺transport is altered during cell activation. In addition to altered Na⁺transport, transport of K⁺ and of Cl⁻ is altered during cellproliferation.

A number of studies have demonstrated that proliferating cells arerelatively depolarized when compared to those that are quiescent ornon-dividing. Differentiation is associated with the expression ofspecific ion channels. Additional studies indicate that cell membranedepolarization occurs because of alterations in ionic fluxes,intracellular ionic composition, and transport mechanisms that areassociated with cell proliferation.

Intracellular Ca²⁺ (Ca²⁺ _(i)) and intracellular pH (pH_(i)) areincreased by mitogen activation. Cell proliferation may be initiatedfollowing the activation of phosphatidylinositol which releases twosecond messengers, 1,2-diacylglycerol and inosotol-1,4,5-triphosphate,which trigger Ca²⁺ _(i) release from internal stores. Ca²⁺ _(i) andpH_(i) may then alter the gating of various ion channels in the cellmembrane, which are responsible for maintaining the voltage of the cellmembrane. Therefore, there is the potential for interaction betweenother intracellular messengers, ion transport mechanisms, and cellmembrane potential. Most studies have been performed in transformed andcultured cells and not in intact epithelia during the development ofcancer, so that it is largely unknown how up-regulated proliferationaffects cell membrane potential, transepithelial potential, epithelialimpedance, and ion transport during carcinogenesis.

It was known that cancer cells are relatively depolarized compared tonon-transformed cells. It has been suggested that sustained cellmembrane depolarization results in continuous cellular proliferation andthat malignant transformation results as a consequence of sustaineddepolarization and a failure of the cell to repolarize after celldivision. C. D. Cone Jr., Unified theory on the basic mechanism ofnormal mitotic control and oncogenesis. J. Theor. Biol. 1971; 30(1):151-181; C. D. Cone Jr., C. M. Cone. Induction of mitosis in matureneurons in central nervous system by sustained depolarization. Science1976; 192(4235): 155-158; C. D. Cone, Jr. The role of the surfaceelectrical transmembrane potential in normal and malignant mitogenesis.Ann. N.Y. Acad. Sci. 1974; 238: 420-435. A number of studies havedemonstrated that cell membrane depolarization occurs duringtransformation and carcinogenesis. Other studies have demonstrated thata single ras-mutation may result in altered ion transport and cellmembrane depolarization. Y. Huang, S. G. Rane, Single channel study of aCa(2+)-activated K+ current associated with ras induced celltransformation. J. Physiol. 1993; 461: 601-618. For example, there is aprogressive depolarization of the colonocyte cell membrane during 1,2dimethylhydrazine (DMH)-induced colon cancer in CF₁ mice. The V_(A)(apical membrane voltage) measured with intracellular microelectrodes inhistologically “normal” colonic epithelium depolarized from −74.9 mV to−61.4 mV after 6 weeks of DMH treatment and to −34 mV by 20 weeks oftreatment.

While epithelial cells normally maintain their intracellular sodiumconcentration within a narrow range, electronmicroprobe analysis showsthat cancer cells exhibit cytoplasmic sodium/potassium ratios that arethree to five times greater than those found in their non-transformedones. These observations partly explain the electrical depolarizationobserved in malignant or pre-malignant tissues, because of the loss ofK⁺ or Na⁺ gradients across the cell membrane.

In addition to cell membrane depolarization, and altered intracellularionic activity, other studies have shown that there may be a decrease inelectrogenic sodium transport and activation of non-electrogenictransporters during the development of epithelial malignancies. Thesechanges may occur as a consequence of altered intracellular ioniccomposition. Other specific ion transport alterations have beendescribed in colon, prostate, breast, uterine cervix, melanoma,urothelium, and pancreas during proliferation, differentiation,apoptosis, and carcinogenesis.

Apoptosis or physiological cell death is down-regulated during thedevelopment of malignancy. Ion transport mechanisms affected byapoptosis include the influx of Ca²⁺, non-selective Ca²⁺-permeablecation channels, calcium-activated chloride channels, andK⁺-Cl⁻-cotransport. J. A. Kim et al. Involvement of Ca2+ influx in themechanism of tamoxifen-induced apoptosis in Hep2G human hepatoblastomacells. Cancer Lett. 1999; 147(1-2): 115-123; A. A. Gutierrez et al.Activation of a Ca2+-permeable cation channel by two different inducersof apoptosis in a human prostatic cancer cell line. J. Physiol. 1999;517 (Pt. 1): 95-107; J. V. Tapia-Vieyra, J. Mas-Oliva. Apoptosis andcell death channels in prostate cancer. Arch. Med. Res. 2001; 32(3):175-185; R. C. Elble, B. U. Pauli. Tumor Suprression by a ProapoptoticCalcium-Activated Chloride Channel in Mammary Epithelium. J. Biol. Chem.2001; 276(44): 40510-40517.

Loss of cell-to-cell communication occurs during carcinogenesis. Thisresults in defective electrical coupling between cells, which ismediated via ions and small molecules through gap junctions, which inturn influences the electrical properties of epithelia.

Polyps or overtly malignant lesions may develop in a background ofdisordered proliferation and altered transepithelial ion transport.Experimental animal studies of large bowel cancer have demonstrated thattransepithelial depolarization is an early feature of the pre-malignantstate. In nasal polyp studies, the lesions had a higher transepithelialpotential, but these lesions were not pre-malignant in the same sense asan adenomatous or pre-malignant colonic polyp, that are usuallydepolarized. Electrical depolarization has been found in biopsies ofmalignant breast tissue. Recently alterations in impedance have beenfound to be associated with the pre-malignant or cancerous state inbreast and bowel.

DC electrical potential alterations have been reported to be useful todiagnose non-malignant conditions such as cystic fibrosis, cancer inanimal models, human cells or isolated tissue, and in man. Differencesin impedance between normal tissue and cancer have been described inanimal models in vitro and have been applied to in vivo cancerdiagnosis. DC potential measurements have not been combined withimpedance measurements to diagnose cancer, however, becauseelectrophysiological alterations that accompany the development ofcancer are generally not fully characterized. Transepithelialdepolarization is an early event during carcinogenesis, which may affecta significant region of the epithelium (a “field defect”). Thisdepolarization is accompanied by functional changes in the epitheliumincluding ion transport and impedance alterations. Early on in theprocess these take the form of increased impedance because of decreasedspecific electrogenic ion transport processes. As the tumor begins todevelop in the pre-malignant epithelium, structural changes occur in thetransformed cells such as a breakdown in tight junctions and nuclearatypia. The structural changes result in a marked reduction in theimpedance of the tumor. The pattern and gradient of electrical changesin the epithelium permit the diagnosis of cancer from a combination ofDC electrical and impedance measurements. Another reason that DCelectropotential and impedance measurements have not been successfullyapplied to cancer diagnosis is that transepithelial potential andimpedance may be quite variable and are affected by the hydration state,dietary salt intake, diurnal or cyclical variation in hormonal level, ornon-specific inflammatory changes and other factors. In the absence ofknowledge about the physiological variables which influencetransepithelial potential and impedance these kinds of measurements maynot be reliable to diagnose pre-malignancy or cancer. Furthermore adetailed understanding of the functional and morphological alterationsthat occur during carcinogenesis permits appropriate electrical probingfor a specifically identified ion transport change that is alteredduring cancer development. For example knowledge that electrogenicsodium absorption is reduced during cancer development in the colonpermits the use of sodium channel blockers (e.g., amiloride) or varyingsodium concentration in the ECM to examine whether there is aninhibitable component of sodium conductance. By varying the depth of themeasurement (by measuring the voltage drop across differently spaceelectrodes), it is possible to obtain topographic and depth informationabout the cancerous changes in the epithelium.

The diagnostic accuracy of current technology using DC electropotentialsor impedance alone has significant limitations. Sensitivity andspecificity for DC electrical measurements in the breast have beenreported as 90% and 55% respectively and 93% and 65% for impedancemeasurements. This would result in an overall diagnostic accuracy ofbetween 72-79%, which is probably too low to result in widespreadadoption. J. Cuzick et al. Electropotential measurements as a newdiagnostic modality for breast cancer. Lancet 1998; 352 (9125): 359-363;A. Malich et al. Electrical impedance scanning for classifyingsuspicious breast lesions: first results. Eur. Radiol. 2000; 10(10):1555-1561. The combination of DC. electrical potentials and impedancespectroscopy may result in a diagnostic accuracy of greater than 90%which will lead to improved clinical utility.

Thus, there remains a need for effective, practical methods of detectingabnormal tissue.

SUMMARY OF THE INVENTION

Methods and systems are provided for determining a condition of aselected region of epithelial tissue and/or an organ in a body as wellas to diagnose disease, susceptibility, premalignancy or cancer and tomeasure response to therapy, introduction of a drug and to assess themargins of a tumor or resection. The methods utilize through the tissueor organ electrical measurements with alternating current applied usingone or more surface or internal electrodes and measuring the electricalresponse using one or more surface electrodes, preferably in combinationwith one or more electrodes in direct or indirect contact withepithelium comprising the organ or tissue under test. The methods arealso useful in combination with DC measurements on the surface of theorgan or tissue under test. Measurement of impedance, admittance,electropotential and dielectric properties is particularly useful,particularly as a function of frequency and position on and in thetissue or organ. Furthermore, to overcome problems and inadequaciesassociated with prior methods, abnormal or cancerous tissue ischaracterized using DC measurements and impedance measurements incombination. DC measurements provide information about the functionalstate of the epithelium and can detect early pre-malignant changes andan adjacent malignancy. Impedance measurements at different frequenciesusing differently spaced electrodes provide depth and topographicinformation to give both structural (high frequency range) andfunctional (low frequency range) information about the tissue beingprobed. Abnormal or cancerous tissue can be detected and characterizedby detecting and measuring transport alterations in mucosal tissues,using ionic substitutions and/or pharmacological and hormonalmanipulations to determine the presence of abnormal pre-cancerous orcancerous cells. A baseline level of transepithelial DC potential,impedance, or other electrophysiological property that is sensitive toalterations in transport in epithelia is measured in the tissue to beevaluated. An agent may be introduced to enhance the transport or makeit possible to detect the transport alteration. The transepithelial DCpotential and/or impedance of the tissue (or other electrophysiologicalproperty that may reflect or make it possible to detect alterations inthe transport) are then measured. Based on the agent introduced and themeasured electrophysiological parameter, the condition of the tissue isdetermined.

A method and system are provided for determining a condition of aselected region of epithelial tissue. At least two current-passingelectrodes are located in proximity to or in contact with a firstsurface of the selected region of the tissue. Alternatively, the currentpassing electrodes may pass current across the tissue or epithelium. Forexample, current may be passed between the urethra and surface of theprostate, accessed per rectum; between the abdominal wall and the bowelmucosal surface; between the skin surface of the breast and the centralbreast ducts accessed by central duct catheter or ductoscope. Aplurality of measuring electrodes is located in contact with or inproximity with the first surface of the selected region of tissue aswell. A signal is established between the current passing electrodes.One or more of the measuring electrodes measures impedance associatedwith the established signal. Alternatively a three electrode system maybe used for measurements whereby one electrode is used for both currentinjection and voltage recording. An agent is introduced into the regionof tissue. The condition of the tissue is determined based on the effectof the agent on measured DC transepithelial potential impedance or otherelectrophysiological characteristics. The electrodes in the describedmethods and apparatus can be used in contact with, in proximity to,over, or inserted into the tissue being examined. It should beunderstood that where the method is described in an embodiment asencompassing one of these arrangements, it is contemplated that it canalso be used interchangeably with the other. For example, where themethod is described as having an electrode in contact with the tissue,the method can also be used with the electrode inserted into or inproximity to the: tissue. Similarly, where the method is described ashaving an electrode in proximity to the tissue, it is contemplated thatthe electrode can also be in contact with or inserted into the tissue.

In order to more accurately detect transport alterations in abnormalpre-cancerous or cancerous epithelial tissue, a pharmacological agentmay be introduced to manipulate the tissue. Pharmacological agents mayinclude agonists of specific ion transport and electrical activity,antagonists of specific ion transport and electrical activity, ionicsubstitutions, and/or hormonal or growth factor stimulation orinhibition of electrical activity.

Depending on the location of the tissue to be investigated, a number ofmethods may be used to administer the pharmacological or hormonalagents. One exemplary method includes introducing the agent directly tothe tissue being investigated, via either direct contact or injection.Another exemplary method includes applying the agent to the skinsurface, wherein the agent acts transcutaneously, or through the skin.Yet. another exemplary method includes electroporation, wherein theepithelium or surface is made permeable by the passage of alternatingcurrent via electrodes in contact or penetrating the organ or epitheliumof interest. The agent then passive diffuses into the organ and itsconstituent cells. Additional exemplary methods include via inhalation,oral administration, lavage, gavage, enema, parenteral injection into avein or artery, sublingually or via the buccal mucosa, or viaintraperitoneal administration. One skilled in the art will appreciatethat other methods are possible and that the method chosen is determinedby the tissue to be investigated.

Thus, systems and methods consistent with the present invention use acombination of transepithelial electropotential and impedancemeasurements to diagnose pre-malignancy or cancer. Further, systems andmethods consistent with the present invention use a defined set offrequencies in combination to characterize functional and structuralalterations in pre-malignancy and cancer. By using spaced electrodes thepresent invention may provide topographic and geometrical (depth)information about the epithelium under examination to diagnosepre-malignancy and cancer. In one embodiment, systems and methods of thepresent invention use electrodes with specially formulated ECMs toprovide functional information about the epithelium to diagnosepre-malignacy and cancer.

Additional objects and advantages of the invention will be set forth inpart in the description which follows, and in part will be obvious fromthe description, or may be learned by practice of the invention. Theobjects and advantages of the invention will be realized and attained bymeans of the elements and combinations particularly pointed out in theappended claims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not restrictive of the invention, as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate at least one embodiment of theinvention and together with the description, serve to explain theprinciples of the invention. In the Figures:

FIG. 1 is a schematic diagram of a DC and AC impedance measuring device,consistent with an embodiment of the present invention;

FIG. 2 illustrates an exemplary embodiment of a device suitable for usewith systems and methods consistent with the present invention;

FIG. 3 illustrates another exemplary embodiment of a device suitable foruse with systems and methods consistent with the present invention;

FIGS. 4A and 4B illustrates other exemplary embodiments of a devicesuitable for use with systems and methods consistent with the presentinvention;

FIGS. 5A and 5B illustrate the short circuit current associated withhuman colonic epithelium ex-vivo;

FIG. 6 is a photomicrograph illustrating electrophysiologic andhistologic alterations that may be present in colonic cancer;

FIG. 7 illustrates measurements of epithelial electropotential in apatient with rectal cancer;

FIG. 8 illustrates varying ionic content and the effect ontransepithelial conductance in human breast epithelium;

FIG. 9 illustrates measurements of cell membrane potential in humanbreast epithelial cells;

FIG. 10 illustrates the effect of increasing estradiol on thetransepithelial potential in benign and malignant breast epithelia;

FIG. 11 illustrates conductance and electropotential measurements madeover the surface of the breast in women with and without breast cancer;

FIG. 12 illustrates the measurement of electropotential at the surfaceof the breast, and variation of the measurement during menstrual cycle

FIG. 13 illustrates measurements of cell membrane potential in humanprostatic epithelial cell under different growth conditions;

FIG. 14 illustrates measurements of electropotential in a patient withnormal prostate; and

FIG. 15 illustrates measurements of electropotential in a patient withprostate cancer.

FIG. 16 illustrates electrical measurements in a female patient with anearly stage carcinoma of the left breast;

FIG. 17 illustrates electrical measurements of involved and uninvolvedportions through the breast of the female patient of FIG. 16;

FIG. 18 illustrates transepithelial electrical measurements of controland tumor-containing portions of the breast of a female patient;

FIG. 19 illustrates electrical measurements using a combination oftransepithelial and through-the-breast measurements in control portionsand portions in which fibrocystic tissue is present;

FIG. 20 is a higher scale magnification of the upper left hand corner ofFIG. 19.

DETAILED DESCRIPTION

For purposes of the present invention the following terms shall have theindicated meanings:

“Electrical measurements” is a generic term and includes one or more ofresistance, reactance, capacitance, admittance, permittivity, andsusceptance. Furthermore, “electrical measurements” include propertiesor characteristics derived from directly or indirectly measuredelectrical properties, including for example, dielectric constants.

“Alternating current (AC)” refers to a varying current and includes sinewave or sinusoidal, square wave or other step function, or varyingcurrent with an irregular or non-repeating pattern. In contrast, “directcurrent (DC)” is a substantially constant or unvarying current;alternatively, it can be thought of as an alternating current of “zero”frequency.

Reference will now be made in detail to an embodiment of the invention,an example of which is illustrated in the accompanying drawings.Wherever possible, the same reference numbers will be used throughoutthe drawings to refer to the same or like parts.

In order to combine DC transepithelial measurement with impedancemeasurements, it may be necessary to obtain baseline measurement of theDC potential using the voltage sensing electrodes, referenced to a lowimpedance surface electrode, or the blood stream via an IV, or theinterstitial body fluid via a needle electrode or electrode thatpermeabilizes the overlying epidermis or other epithelium, or other bodyreference point. The electrodes may contain different ionicconcentrations, pharmacological agents, or hormones in their ECMs. Asused in this description, an ECM is a medium that permits transmissionof electrical signals between the surface being measured and theelectrode. An agent includes any ionic concentration, pharmacologicalagent, hormone, or other compound added to the ECM or otherwiseintroduced to the tissue under investigation, selected to providefurther information about the condition of the tissue. In anotherembodiment the concentrations of agents may be changed using a flowthrough system.

In order to measure the depth of the impedance alteration, a voltagedrop is made between electrodes with different spacing. Spacing isdetermined by knowledge of the depth to be probed. Similarly, twodifferent frequency ranges will be used to measure functional andstructural changes at different depths.

In order to more accurately detect the functional transport alterationsat different depths in abnormal pre-cancerous or cancerous epithelialtissue, an agent, such as a pharmacological agent, may introduced tomanipulate the tissue, while electrically probing the tissue atdifferent frequencies and monitoring the voltage drop betweendifferently spaced electrodes. Pharmacological agents include agonistsof specific ion transport and electrical activity, antagonists ofspecific ion transport and electrical activity, ionic substitutions,and/or hormonal or growth factor stimulation, which modulates, inhibitsor stimulates electrical activity.

Depending on the location of the tissue to be investigated, a number ofmethods may be used to administer the pharmacological or hormonalagents. One exemplary method includes introducing the agent directly tothe tissue being investigated, via either direct contact or injection.Another exemplary method includes applying the agent to the skinsurface, wherein the agent acts transcutaneously, or through the skin.Another exemplary method includes electroporation, wherein theepithelium or surface is made permeable by the passage of alternatingcurrent via electrodes in contact with or penetrating the organ orepithelium of interest. The agent then passively diffuses into the organand its constituent cells. Additional exemplary methods include viainhalation, oral administration, lavage, gavage, enema, parenteralinjection into a vein or artery, sublingually or via the buccal mucosa,or via intraperitoneal administration. One skilled in the art willappreciate that other methods are possible and that the method chosen isdetermined by the tissue to be investigated.

Based on the agent introduced and the tissue being investigated,measurements of electrophysiological properties, such as impedance, areperformed. Other properties that can be measured includes,transepithelial potential, changes in spontaneous oscillations intransepithelial potential or impedance associated with the malignantstate, and time delay in a propagation signal between electrodes, whichindicates a change or loss of gap-junction function. The results ofthese measurements are then used to determine the condition of theinvestigated tissue. For example, research has indicated that specificion transport processes are altered during the development of cancer.For example, a loss of electrogenic Na⁺ transport, an up-regulation inNa/H exchange, a down-regulation in K⁺ conductance, a decrease in basalCl⁻ absorption, and a down-regulation in c-AMP (cyclicadenosine-3′,5′-cyclic monophosphate) stimulated Cl⁻ secretion have beenobserved.

Thus, by administering agents appropriate to the particular epithelialtissue and measuring the associated electrophysiologicalcharacteristics, it is possible to detect abnormal pre-cancerous orcancerous tissue while the development of such tissue is at an earlystage. The method and system of the present invention is applicable toany epithelial derived cancer, such as, but not limited to, prostate,colon, breast, esophageal, and nasopharyngeal cancers, as well as otherepithelial malignancies, such as lung, gastric, uterine cervix,endometrial, skin, and bladder.

Specifically, in cancers affecting mucosal or epithelial tissues,transport alterations may be sufficiently large to suggest that they area consequence of an early mutation, affecting a large number of cells(i.e., a field defect). In this case, they may be exploited as potentialbiomarkers for determining which patients should be either morefrequently monitored, or conversely, may be used to identify particularregions of mucosa that require biopsy. The latter is especially helpfulin the case of flat adenomas or dysplasia, which are more difficult todetect physically than, for example, polyps.

A number of variations are possible for devices to be used with thepresent invention. Further, within a device design, there are a numberof aspects that may be varied. These variations, and others, aredescribed below.

One probe or other device includes a plurality of miniaturizedelectrodes in recessed wells. Disposable commercially available siliconchips processing, such as filtering, may perform surface recording andinitial electronic processing. Each ECM solution or agent may bespecific to the individual electrode and reservoir on the chip. Thus,for one measurement, a particular set of electrodes is used. For anothermeasurement, for example, at a different ionic concentration, adifferent set of electrodes is used. While this produces somevariations, as the electrodes for one measurement are not located at thesame points as for another, this system provides generally reliableresults.

An alternative approach is to use fewer electrodes and use aflow-through or microfluidic system to change solutions and agents.Specifically, solutions or agents are changed by passing small amountsof electrical current to move solution or agent through channels and outthrough pores in the surface of the probe. In this embodiment, theelectrode remains in contact with the same region of the epithelium,thus eliminating region-to-region variation in measurement. Thisapproach requires time for equilibration between different solutions.

In detecting the presence of abnormal pre-cancerous or cancerous breasttissue, a hand-held probe is provided for obtaining surface measurementsat the skin. The probe may include electrodes for passing current aswell as for measuring. An impedance measurement may be taken between thenipple cup electrode and the hand-held probe, or may be taken betweenelectrodes on the hand-held probe. After taking initial DC measurements,a wetting/permeabilizing agent may be introduced to reduce skinimpedance. The agent may be introduced using a microfluidic approach, asdescribed above, to move fluid to the surface of the electrodes.Alternatively, surface electrodes that just penetrate the stratumcorneum may be used to decrease impedance.

Regardless of the configuration of the device, FIG. 1 is a schematic ofa DC and AC impedance measurement system 100 used in cancer diagnosis,consistent with the present invention. The system 100 interfaces with aprobe device 105 including multiple electrodes, wherein the actualimplementation of the probe device 105 depends on the organ andcondition under test. The probe device 105 may incorporate theelectrodes attached to a glove, needle, body cavity, endoscopic, orsurface probe. A reference probe 110 may take the form of an intravenousprobe, skin surface probe, or epithelial surface reference probedepending on the test situation and organ under investigation.

To avoid stray capacitances, the electrodes may be connected viashielded wires to a selection switch 120 which may select a specificprobe 105 following a command from the Digital Signal Processor (DSP)130. The selection switch 120 also selects the appropriate filterinterfaced to the probe 105, such that a low pass filter is used duringDC measurements and/or an intermediate or high pass filter is usedduring the AC impedance measurements. The selection switch 120 passesthe current to an amplifier array 140 which may be comprised of multipleamplifiers or switch the signals from different electrodes through thesame amplifiers when multiple electrodes are employed. In a preferredembodiment digital or analogue lock-in amplifiers are used to detectminute signals buried in noise. This enables the measurement of thesignal of interest as an amplitude modulation on a reference frequency.The switching element may average, sample, or select the signal ofinterest depending on the context of the measurement. This processing ofthe signal will be controlled by the DSP following commands from theCPU. The signals then pass to a multiplexer 150, and are serializedbefore conversion from an analogue to a digital signal by the ADC. Aprogrammable gain amplifier 160 matches the input signal to the range ofthe ADC 170. The output of the ADC 170 passes to the DSP 130. The DSP130 processes the information to calculate the DC potential and itspattern on the epithelial or skin surface as well as over the region ofsuspicion. In addition the impedance at varying depth and response ofthe DC potential and impedance to different ECM concentrations of ions,drug, hormones, or other agent are used to estimate the probability ofcancer. The results are then sent to the CPU 180 to give a test result185.

Alternatively the signal interpretation may partly or completely takeplace in the CPU 180. An arbitrary waveform generator 190 or sine wavefrequency generator will be used to send a composite waveform signal tothe probe electrodes and tissue under test. The measured signal response(in the case of the composite wave form stimulus) may be deconvolvedusing FFT (Fast Fourier Transforms) in the DSP 130 or CPU 180 from whichthe impedance profile is measured under the different test conditions.An internal calibration reference 195 is used for internal calibrationof the system for impedance measurements. DC calibration may beperformed externally, calibrating the probe being utilized against anexternal reference electrolyte solution.

FIG. 2 illustrates a glove that may be used, for example, in diagnosisof prostate cancer or as a screening test for colorectal neoplasia.Multiple sensor electrode arrays may be attached to an examining glovetogether with current passing electrodes. The individual electrodes maybe recessed and ECMs with different composition may be used topharmacologically, electrophysiologically, or hormonally probe theepithelium under test. Spacing of the electrodes may be greater for theprostate configuration than for other organ systems so that deepertissue may be electrically probed and the impedance of the deeper tissueevaluated. The electrodes will be interfaced via electrical wire, orwireless technology, with the device described in FIG. 1 above.

FIG. 3 is a schematic of an endoscopic probe, consistent with thepresent invention, which may be placed in contact with the epitheliumendoscopically. This probe may either be placed passively in contactwith the epithelium or held in place by pneumatic suction over theregion of interest. Ports are in place for the exchange of solutions orfor fluid exchange and suction. Guard rings may be incorporated toprevent cross-talk between electrodes and to force current from thecontact surface into the epithelium. In this configuration there arefour current passing electrodes each positioned radially 90° apart. Thispermits current to be passed and the voltage response to be measured inperpendicular fields. This enables the effects of surface asymmetry onimpedance (such as occurs with aberrant crypt foci) to be measured.Electrodes may be slightly recessed so as not to influence currentdensity measured at the surface.

FIG. 4A includes a handheld probe 400, consistent with the presentinvention, which may be applied to the surface of the breast. The probemay include a handle 410. The probe 400 may be attached, either directlyor indirectly using, for example, wireless technology, to a measurementdevice 420. The probe 400 may be referenced to an intravenous electrode,a skin surface electrode, or other ground. In one embodiment,illustrated in FIG. 4A, the reference is a nipple electrode or ductalprobe 430, illustrated in greater detail at close-up 440. One advantageof this configuration is that DC electropotential and impedance can bemeasured between the nipple electrode 430 and the probe 400. Themeasurement is thus a combination of the DC potentials and impedance ofthe breast ductal epithelium, non-ductal breast parenchyma, and theskin.

Referring to close-up 440, the ductal probe is inserted into one ofseveral ductal orifices that open onto the surface of the nipple. Ductalprobe 443 is shown within a ductal sinus 444, which drains a largercollecting duct 445.

Another advantage of using a nipple electrode is that a solution forirrigating the ductal system may be exchanged through the probe,permitting introduction of pharmacological and/or hormonal agents. Asshown in magnified nipple probe 443, 443′ fluid can be exchanged througha side port. Fluid may be infused into the duct and aspirated at theproximal end (away from the nipple) of the nipple probe. Differentelectrolyte solutions may be infused into the duct to measure alteredpermeability of the ductal epithelium to specific ions or the epitheliummay be probed with different drugs to identify regions of abnormality.Estradiol, or other hormonal agents, may be infused into a breast ductto measure the abnormal electrical response associated withpre-malignant or malignant changes in the epithelium.

It should be understood that different configurations may also be used,such as a modified Sartorius cup that applies suction to the nipple.With this configuration, gentle suction is applied to a cup placed overthe nipple. Small amounts of fluid within the large ducts and ductsinues make contact with the electrolyte solution within the Sartoriuscup, establishing electrical contact with the fluid filling the breastducts. DC or AC measurements may then be made between the cup and asurface breast probe.

FIG. 4B illustrates the probe 400 of FIG. 4A in greater detail. The skincontact of the surface 450 is placed in contact with the breast. Thesurface electrodes 451 measure DC or AC voltages. The current passingelectrodes 452 are used for impedance measurements. Probe 400 may alsoinclude one or more recessed wells containing one or more ECMS.

Further embodiments of this technique may involve the use of spacedelectrodes to probe different depths of the breast, and the use ofhormones, drugs, and other agents to differentially alter the impedanceand transepithelial potential from benign and malignant breast tissue,measured at the skin surface. This enables further improvements indiagnostic accuracy.

EXAMPLE 1 Colon Cancer

In colon cancer, the following electrophysiological changes have beenobserved during the development of the abnormal tissue: loss ofelectrogenic Na+ transport, up-regulation in Na/H exchange,down-regulation in K⁺ conductance, decrease in basal Cl⁻ absorption, anddown-regulation in c-AMP (cyclic adenosine-3′,5′-cyclic monophosphate)stimulated Cl⁻ secretion. A number of pharmacological and hormonalmanipulations can be performed to detect these ion transportalterations.

By using electrolyte conductive medium (ECM) of differentconcentrations, the conductance of specific ions can be estimated andthe response to different pharmacological probes can be determined.Different pharmacological agents are administered that influenceelectrophysiological properties of normal bowel, but have minimal ordifferent effects on pre-cancerous or cancerous tissue. For example,glucocorticoids or mineralocorticoids, administered by injection ororally, increase the transepithelial electropotential (TEP) of normalcolon, but have a lesser effect on pre-cancerous or cancerous tissue.These steroids up-regulate electrogenic sodium absorption, therebydecreasing sodium specific impedance in normal colon.

The measured TEP decreases in response to a topically applied amiloride(a sodium channel blocker) in normal colonic mucosa. This response isreduced by approximately 50% in pre-cancerous mucosa or by greater than75% in cancerous mucosa. In addition, the loss in sodium conductanceresults in an increase of impedance of the surface epithelium. This iontransport alteration may be measured by determining the change in TEP aswell as the basal impedance. In abnormal pre-cancerous or canceroustissue, the TEP is lower, the response of the TEP to amiloride is less,and the increase in impedance (observed in normal colon in response toamiloride) is less in abnormal pre-cancerous or cancerous tissue.Similar pharmacological agents may be introduced that alter the effectof chloride or potassium ion transport, which affect abnormalpre-cancerous or cancerous tissue in a different manner than in normalcolon tissue.

It is important to note that the impedance is higher, or conductance isgenerally lower, around the edge of the tumor or in the immediatelyadjacent pre-malignant epithelium. At more than 5-10 cm from the tumorthe TEP is lower and ion specific impedances may be higher. In the tumoritself the impedance is lower (conductance higher). Measurement may bemade over a suspected tumor, but also adjacent and some distance awayfrom the suspected tumor to more accurately identify the cancerous orpre-cancerous tissue. There are also pharmacological differences betweennormal pre-cancerous and cancer tissue. Direct comparison between thesedifferent regions can used to make a more accurate diagnosis of canceror premalignancy.

In one embodiment, electrophysiological measurements are performed usinga series of two or more electrodes attached to an examining glove orprobe. Some factors influencing the spacing of the electrode and thesignal used include the depth of penetration desired andpermeabilization of the surface epithelium using penetrating agents. Aprobe that permits variable frequency signals and varying electrodeplacement provides the most versatile arrangement, but a probe or gloveproviding a single frequency signal and/or static electrode placementmay also be used.

Sodium: Sodium conductance and absorptive properties in the surfacecells of the colonic epithelium are markedly attenuated in somepre-cancerous and cancerous cells. By measuring the impedance of thecolonic epithelium using low frequency sine waves and closely placedelectrodes, it is possible to determine the electrophysiologicalactivity of the surface cells. Passive electrodes, placed betweencurrent-passing electrodes, measure the impedance, while ECMs ofdifferent sodium concentration may be used to reveal alterations of thespecific ionic permeabilities of the epithelium. By using higherfrequency sine waves and widely spaced electrodes and ECMs of varyingsodium concentration, it is possible to estimate overall andion-specific conductances of the deeper epithelium. A ratio may bedetermined, expressed as the change in surface to deep sodiumconductance. The surface/deep sodium conductance ratio progressivelydecreases as tissue develops from at-risk, to pre-cancerous to canceroustissue. The surface cells that are conductive to sodium are replaced bycells from the deeper epithelium that do not have as high a conductance.Therefore, the ratio of surface Na⁺ conductance/deep Na⁺ conductancegoes from >2.0 to <1.0. Both the ratio and absolute number change.Measuring the ratio effectively normalizes the measurement for theparticular individual and epithelial region under test.

A number of ECMs and pharmacological agents may be employed tocharacterize the sodium transport characteristics of colonic tissue. Inone exemplary method, initial measurements are made using an electrolytesolution containing 10 mM KCl in the ECM, either in gel or solution,which interfaces between the electrode and the bowel wall. Measurementsare taken relative to an intravenous reference electrode or a lowimpedance skin electrode, having a minimal offset voltage relative tothe underlying extracellular fluid and bloodstream. The TEP is thenmeasured at increasing levels of sodium, both in the absence andpresence of amiloride or similar agent, such as benzamil, (10 μM-1 mM)to block electrogenic sodium transport. The difference between the twomeasurements will be the TEP attributable to the electrogenic sodiumtransport across the bowel epithelium. The electrogenic component ofsodium transport is diminished by 40-50% in colonic epithelium that isat-risk or pre-cancerous.

One method for varying the sodium and/or pharmacological content duringmeasurement include using one or more wells or reservoirs associatedwith each electrode, containing different concentrations of electrolyteand/or agent, so that the solution is not actually changed duringmeasurement but the measurement occurs under different conditions withdifferent electrodes and ECMs. Another method involves a flow-throughsolution change system, whereby solution changes may be automated whileusing fewer electrodes.

Potassium: Measurements similar to that described above, with referenceto sodium, are performed with reference to potassium. Specifically, anearly decrease in potassium conductance is associated with at-risk orpre-cancerous colonic epithelium. As cancer develops, potassiumconductance becomes up regulated and potassium secretion may beenhanced. The decrease, and then increase, in potassium conductanceenables not only identification of abnormal tissue, but also thedetermination of the condition of the tissue, as either normal, at-risk,pre-cancerous, or cancerous.

Impedance measurements may be performed at varying concentrations ofpotassium, using signals of varying frequency, and using variably spacedelectrodes, thus providing an impedance profile including thesuperficial and deep epithelium. For example, one method of determiningan impedance profile, with reference to potassium, is as follows: A TEPmeasurement is made using increasing concentrations of K⁺ and allmeasurements are performed using ECM containing amiloride or anotherblocker of the electrogenic Na⁺ pump to remove the contribution ofelectrogenic Na⁺ transport to TEP. Using the well method describedabove, the ECM in each well contains a combination of amiloride,bethanacol, forskolin, and 3-isobutyl-1-methylxanthine (IBMX). Each ofthe four wells contains varying K⁺ concentrations (between 10 and 80mM), while maintaining the concentration of Na and Cl ions. These agents(bethanacol, forkskolin, and IBMX) depolarize the cell membrane bymaximally opening Cl conduction channels in the surface cells of thecolon. This cell membrane depolarization results in the opening ofvoltage-sensitive K+ channels in the cell membrane. Specifically,bethanacol (or carbacol) raises intracellular Ca²⁺ which opens Ca²⁺sensitive K⁺ channels, as well as increasing chloride secretion openingup Cl⁻ channels. Other muscarinic agonists may produce similar results.Forkskolin increases adenyl cyclase, thereby raising intracellular c-AMPopening up K⁺-channels. IBMX, a phosphodiesterase inhibitor, may be usedto raise c-AMP. Other agents, such as theophylline, may also be used toraise c-AMP. Agents, such as dibutyrl c-AMP, may be used to increasec-AMP directly. These agents maximally increase potassium conductanceand secretion, permitting the identification of reduced potassiumsecretion and conductance associated with at-risk or pre-canceroustissue.

Another such method employs measurements with a series of varying KClconcentrations in contact with the colonic mucosa, such as 10, 20, 40,and 80 mM KCl. Electrodes containing 10 μM-1 mM amiloride in the ECM areused to measure TEP and impedance, both in the presence and absence ofK⁺-channel blockers, such as 20 mM TEA (tetraethyl ammonium) and 5 mMbarium. The TEP is lower than normal in the at-risk and pre-canceroustissue. The impedance is lower than normal in the cancerous tissue. Intransitional tissue or tissue adjacent to developing cancer, impedancemay be higher than normal.

Chloride: Similar to the methods for sodium and potassium describedabove, chloride conductance can be used to determine abnormalpre-cancerous and cancerous tissue. Chloride conductance occurs mainlyat the base of the crypt (or deep) in normal epithelium. In canceroustissue, the epithelial cells closer to the surface of the crypt becomemore conductive to chloride, albeit at a lower level of conductance thanobserved in the base. The ratio of chloride conductance between thesurface and the base, as estimated from impedance measurements, can beused to characterize colonic tissue as either normal, at-risk,pre-cancerous, or cancerous. Specifically, at-risk and pre-cancerousepithelium exhibits an overall decrease in chloride conductance, with anincrease in the surface/base ratio. As the tissue progresses tocancerous, the overall chloride conductance increases and is accompaniedby increased Cl⁻ secretion. The surface/base ratio may become lessdiscriminatory, however, because normal epithelial morphology is lost ina malignant tumor.

As with potassium, chloride-dependent TEP is measured using increasingconcentrations of Cl⁻. Measurements are made in the presence of an ECMcontaining a sodium pump blocker agent, such as amiloride, in order tonegate the contribution of electrogenic Na⁺ transport, and agents, suchas bethanacol, forskolin, and IBMX to maximally open Cl⁻ conductionchannels in the surface cells of the colon. The wells have Cl−concentrations varying between 15 and 120 mM, while maintaining theconcentrations of Na and K ions and keeping osmolality constant. Inat-risk and pre-cancerous tissue, the Cl⁻ is reduced. Additionally, theTEP is lower than normal. In cancerous tissue, the basal Cl⁻ secretionand Cl⁻ conductance is increased.

Drug Provocation: In addition to the ionic manipulations describedabove, the colon responds to a number of different hormones, growthfactors, and diets by changing the ion transport characteristics of theepithelium. For example, aldosterone (a mineralocorticoid) anddexamethasone (a glucocorticoid) both increase electrogenic sodiumabsorption and potassium secretion in the colon. In normal colon, sodiumconductance is increased in surface cells and the epitheliumhyperpolarizes, or becomes more negative in the lumen. Potassiumconductance increases in the deeper cells. In at-risk, pre-cancerous, orcancerous tissue, however, this response is significantly different. Thehyperpolarization and increase in sodium conductance is markedlydiminished. The increase in the potassium conductance in the basal cellsof the crypt is much less than occurs in normal colon. Thus, agents andtreatments that affect the ion transport characteristics of theepithelium may be used to enhance differences between normal andabnormal colon tissue in impedance measurements and/or othermeasurements of the electrical characteristics. A high-potassium,low-sodium diet will produce similar effects in a normal bowel. Otheragents may be administered directly to the surface of the bowel andproduce similar effects in normal epithelium. Carbenoxolone, forexample, when administered rectally, increases TEP in normal bowel, buthas a lesser effect on pre-cancerous or cancerous tissue. It causes anincrease in TEP because it inactivates 11β-HSD (11-beta hydroxysteroiddehydrogenase). Cortisol has mineralocorticoid effects on the bowel andincreases electrogenic sodium absorption and therefore increases TEP innormal but not in abnormal or cancerous bowel epithelium.

FIG. 5A demonstrates the short circuit current of human colonicepithelium ex-vivo. The figure demonstrates the time course along thex-axis while varying the potassium gradient across the tissue. Thepotassium permeability of the apical membrane of human colonic mucosa(P^(K) _(a)) was determined in surgical specimens of controls andgrossly normal-appearing mucosa obtained 10-30 cm proximal to colorectaladenocarcinomas. The mucosa was mounted in Ussing chambers and thebasolateral membrane resistance and voltage were nullified by elevatingthe K⁺ in the serosal bathing solution. The apical sodium (Na⁺)conductance was blocked with 0.1 mM amiloride. This protocol reduces theequivalent circuit model of the epithelium to an apical membraneconductance and electromotive force in parallel with the paracellularpathway as has been verified by microelectrode studies. Increasingserosal K⁺ caused the I_(sc) to become negative (−140 μA/cm²) in normalcolon after which 30 mM mucosal TEA caused an abrupt increase in Isccorresponding to block of apical K⁺ channels. In cancer-bearing colonthe reduction in Isc is to −65 μA/cm². The serosal bath was remainedconstant at 125 mM [K].

FIG. 5B demonstrates that ΔI_(sc), determined with respect to the I_(sc)at 125 mM mucosal K, is a linear function of the concentration gradient,Δ[K]. Because the voltage across the apical membrane is zero under theseconditions and the paracellular pathway is nonselective, the P^(K) _(a)(apical potassium permeability) can be calculated using the Fickequation—i.e., I_(sc)=F×P^(K) _(a)Δ[K] where F is the Faraday constantand Δ[K] is the concentration difference for K⁺ across the epithelium.FIG. 5 b demonstrates mean±sem values for I_(sc) in both normal andpremalignant human distal colon. The apical K⁺ permeability of controlswas 9.34×10⁻⁶ cm/sec and this was significantly reduced by 50% inpremalignant human mucosa to 4.45×10⁻⁶ cm/sec. P^(K) _(a) could also becalculated for the change in I_(sc) when the K⁺ channels were blockedwith TEA, assuming complete block. This resulted somewhat lower valuesof 6.4×10⁻⁶ cm/sec and 3.8×10⁻⁶ cm/sec corresponding to a 40% reductionin P^(K) _(a).

These observations show that there is a field change in the K⁺permeability and conductance of human colon, during the development ofcancer. Impedance measurements, DC measurement using electrodes withdifferent potassium gradients together with specific drugs, such asamiloride to block the contributions of electrogenic Na⁺ transport tothe electrical properties of the bowel are useful to diagnose coloncancer.

FIG. 6 is a photomicrograph which illustrates some of the complexitiesassociated with electrophysiological and histological alterations thatoccur in the development of colonic cancer. The cancer is a 10 mm indiameter, invasive and an ulcerated lesion that could easily be missedat colonoscopy (because it is a depressed lesion). The cancer isdepolarized to 0 mV with a much higher conductance than the surroundingepithelium. The surrounding or adjacent epithelium is also depolarizedat about −20 mV but has a higher impedance than the cancer or normalepithelium. Note that the darker layer, the epithelium (e), is on thetop surface. This is one cell layer thick, but form crypts, likeinverted test tubes with proliferation and secretory function at thebase and differentiated cells and absorptive function at the mouth. Theinferior layer (m) is the muscle layer of the bowel. This small tumorhas already invaded the muscle layer. More distant epithelium is alsodepolarized but to a lesser degree at −40 mV. Potassium conductance isdecreased in this morphologically normal-appearing epithelium. Chloridesecretion is also decreased compared to the tumor, which may activelysecrete chloride. The sodium conductance, G_(Na), is decreased and theNa/H exchanger is upregulated. The colonic mucosa tends to be thickenedwith elongated crypts in the region of the developing cancer (adjacentzone). Most of the impedance resides in the epithelial layer, andtherefore a higher impedance below 750 μm indicates an epithelialthickening associated with cancer. Recognizing the electrophysiologicalpattern enables a diagnosis of cancer to be made, i.e. anelectrophysiological virtual biopsy.

FIG. 7 demonstrates measurements of surface mucosal (epithelial)electropotential referenced to the serosal surface on a freshly excisedspecimen of pelvic colon and rectum from a 45-year-old male with anulcerated rectal carcinoma. Following resection the specimen wasimmediately opened in a longitudinal direction and surfaceelectropotential measurements were made using different ECMs. Followingexcision there is usually a decrease in the electropotential(“run-down”) of 5-10 mV in the first 5-10 minutes, although the relativeelectropotential differences from region to region remain similar.

The “starburst” at the lower end of the figure, 2-3 cms from the analcanal and 5 cms from the anal verge has an electropotential of +10 mVmeasured over the surface of the tumor (left hand column “NormosolRingers's”). Normosol Ringer's is a physiological saline solutioncontaining approximately 5 mM K⁺. The normal mucosal surfaceelectropotential is −50 to −70 mV in the rectum. As measurement aretaken some distance from the tumor the bowel remains depolarized even upto 20 cm from the edge of the tumor where readings of −40 to −45 mV areobserved. This region is depolarized relative to normal colon wherelevels of less than −50 mV are observed.

When electropotential measurements are made in normal colon using an ECMwith a higher K⁺ concentration an increase in electropotential(increased positivity) of 20 mV or greater is frequently observed. Thisis because the normal colon is selectively permeable to K⁺ and theincreased ECM K⁺ concentration sets up a diffusion potential for K⁺across the ion-selective conductance pathways. In the cancer bearingcolon K+ conductance decreases in the region of the developing tumor aswell as some distance from it (“field-cancerization”). Up to 5 cm fromthe developing cancer there is essentially no change in the measuredelectropotential when the ECM is changed from 5 to 30 mM K⁺ (change fromleft column (“Normosol Ringer's”) to middle column “30 mM KCl” infigure). Up to 20 cm from the tumor the change in electropotential doesnot exceed 15 mV (−45 to −30 mV) 20 cms from the edge of the tumor. Afurther increase in the K⁺ concentration of the ECM results in smallincreases in positivity away from the tumor or an anomalous decrease inpositivity near or at the tumor, suggesting that a diffusion gradientfor a different ion (other than K⁺) is set-up in the vicinity of thetumor.

Depolarization in combination with altered K⁺ conductance andpermeability may be used to diagnose the presence of cancer or increasedrisk of cancer. Altered K⁺ conductance is observed before tumors developin the bowel. Combination with simultaneous impedance measurementsincreases diagnostic accuracy.

EXAMPLE 2 Breast Cancer

As mentioned above, impedance and DC electrical potential have been usedseparately at the skin's surface to diagnose breast cancer. In thecurrent invention, the impedance characteristics of the overlying skinor epithelium are measured and factored in to the diagnosticinterpretation of the data. For example the surface potential may bemore positive (or less negative) than the reference site because ofincreased conductance of the overlying skin, rather than because of anunderlying tumor.

The electrodes are placed over the suspicious region and the passive DCpotential is measured. Then AC impedance measurements are made asdiscussed below. The variable impedance properties of the overlying skinmay attenuate or increase the measured DC surface electropotentials.Alternatively, impedance measurements at different frequencies mayinitially include a superimposed continuous sine wave on top of anapplied DC voltage. Phase, DC voltage and AC voltage will be measured.The resistance of the skin or other epithelium at AC and a differentresistance at DC are measured. Under DC conditions since there is nophase shift we are able to measure the transepithelial potential at thesurface. The capacitive properties of the skin allow the underlyingbreast epithelial and tumor potential to be measured at the skinsurface.

Once the ECM results in “wetting” of the skin surface there ispseudo-exponential decay in the skin surface potential using the abovereferenced approach. Ions in the ECM diffuse through the skin and makeit more conductive, particularly because of changes in the skin parallelresistance. The time constant for this decay is inversely proportionalto the concentration and ionic strength of the gel. Once the skin isrendered more conductive by the ECM the capacitive coupling of thesurface to the underlying potential of the tumor or the surroundingepithelium is lost so that the measured potential now reflects an offsetand diffusion potential at the electrode-ECM-skin interfaces.

The use of pharmacological and/or hormonal agents, however, incombination with both impedance and DC electrical potential, provides aneven more effective method for detecting abnormal pre-cancerous orcancerous breast tissue. Breast cancer develops within a background ofdisordered proliferation, which primarily affects the terminal ductallobular units (TDLUs). The TDLUs are lined by epithelial cells, whichmaintain a TEP. In regions of up-regulated proliferation, the ducts aredepolarized. The depolarization of ducts under the skin surface iscapacitively coupled with the overlying skin, which results in skindepolarization. When a tumor develops in a region of up-regulatedproliferation the overlying breast skin becomes further depolarizedcompared with other regions of the breast and the impedance of thecancerous breast tissue decreases. Electrophysiological responses in TEPand impedance change under the influence of hormones and menstrualcycle.

For example, the electrophysiological response of breast tissue to17-β-estradiol has been observed to be different in pre-cancerous orcancerous tissue than in normal breast tissue. In one method of presentinvention, estradiol is introduced directly into the duct orsystematically following sublingual administration of 17-β-estradiol (4mg). This agent produces a rapid response, which peaks at approximately20 minutes. The electrophysiological response depends, in part, on thestage of the patient's menstrual cycle, as well as the condition of thebreast tissue. Specifically, in normal breast tissue, a rise in TEP willoccur during the follicular (or early) phase. In pre-cancerous orcancerous tissue, this response is abrogated. Post-menopausal women atrisk for breast cancer may have an exaggerated TEP response to estradiolbecause of up-regulated estrogen receptors on epithelial cell surfaces.

FIG. 8 demonstrates the effect of varying the ionic content of thebathing Ringers solution on transepithelial conductance. The humanbreast epithelial cells were grown as monolayers on Millipore filtersand grew to confluence in 7 to 10 days. The epithelia were then mountedin modified Ussing chambers and the DC conductances were measured usinga voltage clamp. The conductance was measured by passing a 2 μA currentpulse for 200 milliseconds and measuring the DC voltage response andcalculating the transepithelial conductance (y-axis), and plotting itagainst time (x-axis). The conductance was measured first in standardRinger solution, then in a sodium-free Ringer, then returned to standardRinger, then in a potassium-free Ringer and finally returning tostandard Ringer solution while maintaining normal osmolality during thestudies.

The upper plot (filled squares and solid line) demonstrates theconductance of benign human breast epithelia grown as a monolayer. Theconductance is higher in the benign epithelial cells. The Na⁺ and K⁺components of conductance are approximately, 10 and 5 mS.cm⁻²respectively.

The lower plot (filled circles and dotted line) demonstrates theconductance of malignant human breast epithelia grown as a monolayer.The conductance is significantly lower in the malignant epithelialcells. The Na⁺ and K⁺ components of conductance are approximately, 4 and1 mS.cm⁻² respectively.

In malignant tumors as opposed to monolayers of malignant epithelialcells the tight junction between cells break down and the tumor becomesmore conductive than either benign or malignant epithelial monolayers.This observation may be exploited in the diagnosis of breast cancer. Thelower conductance of the epithelium around a developing tumor, togetherwith a region of high conductance at the site of the malignancy, may beused to more accurately diagnose breast cancer. Using electrodes withECMs with different ionic composition will permit the specific ionicconductances to be used in cancer diagnosis. For example a highconductance region with a surrounding area of low K-conductance isindicative of breast cancer, A high conductance area with a surroundingregion of normal conductance may be more indicative of fibrocysticdisease (a benign process).

FIG. 9 demonstrates measurements of cell membrane potential (Ψ) in humanbreast epithelial cells. Measurements were made using a potentiometricfluorescent probe, and ratiometric measurements, which are calibratedusing valinomycin and K⁺-gradients. Ψs were measured in the presence(closed circles) and absence (open circles) of estradiol (the activemetabolite of estrogen). Each symbol is the mean measurement. The uppererror bar is the standard error of the mean, and the lower error bar isthe 95% confidence level for the observations. The addition of estrogento cultured breast epithelial cells results in an instantaneous increasein Ψ (data not shown) as well as transepithelial potential see FIG. 10.Transepithelial potential (V_(T)) of an epithelium is the sum of theapical (luminal) cell membrane potential (V_(A)) and the basolateral(abluminal) cell membrane potential (V_(BL)). ThereforeV_(T)=V_(A)+V_(BL) (changes in V_(A) and V_(BL) will therefore alterV_(T) or transepithelial potential).

FIG. 9 demonstrates that benign breast epithelial cells have a Ψ ofapproximately −50 mV in the absence of estradiol and −70 mV whenestradiol is added to the culture media. Malignant and transformed cellshave a Ψ of between −31 and −35 mV in the absence of estradiol andapproximately 50 mV when estradiol is present in the culture medium.

The difference in the electrical properties may be exploited to diagnosebreast cancer in vivo. Surface electropotential measurements are acombination of the transepithelial potential, tumor potential andoverlying skin potential. Physiological doses of estradiol may beadministered to the patient to increase Ψ and the sustained effect ofestradiol results in an increase in transepithelial potential and tumorpotential measured as an increase in surface electropotential. Theincrease following sustained exposure (as opposed to the instantaneousresponse) is less in malignant than benign breast tissue.

It should be noted that the instantaneous response, illustrated in FIG.10, is greater in malignant epithelia, whereas the chronic or sustainedexposure to estradiol results in a lower increase in TEP(transepithelial electropotential) in malignant cells. Concurrentmeasurement of surface electropotential and impedance allow the moreaccurate diagnosis of cancer. FIG. 10 demonstrates the instantaneouseffect of increasing doses of estradiol on the transepithelial potential(TEP) of benign and malignant human breast epithelial cells. The cellswere grown as monolayers on Millipore filters and grew to confluence in7 to 10 days. The epithelia were then mounted in modified Ussingchambers and the TEP was measured using a voltage clamp. Increasingdoses of estradiol between 0 and 0.8 μM were added (x-axis). Thetransepithelial potential was measured after each addition and the TEPwas measured (y-axis).

The different dose response is apparent for benign and malignantepithelia. Malignant epithelia have a lower TEP but undergo aninstantaneous increase in TEP of approximately 9 mV (becomes moreelectronegative and reaches a level of <6 mV) after exposure to only 0.1μM estradiol and then depolarize to approximately −2 mV with increasingdoses of estradiol up to about 0.5 μM. Benign epithelia have a lesserresponse to increasing doses of estradiol and do not peak until almost0.3 μM and then remain persistently elevated (higher electronegativity), unlike the malignant epithelia, with increasing doses ofestradiol.

This difference in dose response may be exploited to diagnose breastcancer. Estradiol, or other estrogens, at a low dose will beadministered systemically, transcutaneously, or by other route. Theinstantaneous response of the surface electropotential and impedance maythen be used to diagnose breast cancer with improved accuracy overexisting diagnostic modalities using impedance or DC measurement alone.

FIG. 11 shows conductance measurements made at 2000 Hz at the surface ofthe breast. At this frequency the influence of the overlying skinimpedance is less. There is still however some variable component ofskin impedance, which results in significant variability of themeasurement as evidenced by the overlapping error bars. Each symbolrepresents the median measurement with error bars the standard deviationof the mean.

Open symbols represent measurements made in patients with a biopsyproven malignancy, while closed symbols represent measurements made inpatients whose subsequent biopsy proved to be a benign process such asfibrocystic disease. Malignant lesions are often associated withsurrounding breast epithelium that demonstrates up-regulatedproliferation. These regions (“adjacent region”) are depolarized and mayhave a lower conductance than either over the region of malignancy. Thisdecreased conductance may be because of decreased K⁺-conductance of theadjacent and pre-malignant epithelium as I have observed in human colon.

Each of the three groups of symbols represents measurements from over asuspicious lesion or region, then the adjacent region, and then overnormal breast in an uninvolved quadrant of the breast. The first twosymbols (circles) in each of the three groups are impedance measurementswhere the median value is plotted against the left y-axis as conductancein mS.cm². The second two symbols (squares) is the surface electricalpotential measured in mV and plotted against the right y-axis; eachdivision equals 5 mV. The third two symbols (triangles) is theelectrical index for benign and malignant lesions and is in arbitraryunits and is derived from the conductance and surface potentialmeasurement. It is immediately apparent that there is less overlap inthe error bars (standard deviation of the mean). Therefore breast cancercan be more accurately diagnosed using a combination of surfacepotential measurement and AC-impedance measurements. Furtherenhancements of this technique will involve the use of spaced electrodesto probe different depths of the breast, and the use of the hormones,drugs and other agents to differentially alter the impedance andtransepithelial potential from benign and malignant breast tissue, andmeasured at the skin surface. This will enable further improvements indiagnostic accuracy.

It should be understood that the surface potential measurement of breasttissue varies based on the position of the woman in her menstrual cycle.FIG. 12 illustrates this variance. This figure demonstrateselectropotential measurements taken over the surface of each breast at 8different locations with an array of 8 electrodes on each breastreferenced to an electrode on the skin of the upper abdomen.Measurements are taken with error bars equal to the standard error ofthe mean. Filled circles and filled squares represent the median valuefrom the left and right breast respectively. The vertical dotted line isthe first day of each menstrual cycle.

It can be seen that the median values for each breast tend to track oneanother with lower values in the first half of menstrual cycle(follicular phase) and higher values in the latter part of cycle (lutealphase). Although the measured electrical values are not completelysuperimposed, because of other factors affecting the electropotential ofthe breast, it can be seen that the lowest levels of electropotentialare observed 8-10 days before menstruation and the rise to the highestlevels around the time of menstruation. This may be because estradiollevels are higher in the second part of menstrual cycle and directlyaffect breast surface electropotential.

The cyclical pattern of electropotential activity when a breast canceror proliferative lesion is present is quite different. Similarly higherlevels of surface electropotential are observed when measurements weremade in the afternoon compared with the morning. This information can beexploited in a number of different ways. Measurement of the surfacepotential and impedance at different times during cycle enables a moreaccurate diagnosis because of a different cyclical change in surfaceelectropotential (i.e., the peak to peak change in potential is lessover a malignant region, relative to normal areas of the breast).Secondly, estradiol or another agent that changes the electropotentialof the breast may be administered systemically, topically (transdermal),or by other means, and the drug or hormone-induced change in surfacepotential may be used as a provocative test to diagnose breast cancer.

In these ways breast cancer can be more accurately diagnosed using acombination of surface potential measurement and AC-impedancemeasurements.

EXAMPLE 3 Nasopharyngeal Cancer

Using methods similar to those described with respect to colon cancer,it is possible to use pharmacological and hormonal agents to enhanceelectrophysiological alterations caused by nasopharyngeal cancer. Oneexemplary method would be a nasopharyngeal probe that would includewells providing for varying concentrations of K⁺ and would performsimple DC measurements.

EXAMPLE 4 Prostate

FIG. 13 represent measurements of cell membrane potential (Ψ) in humanprostatic epithelial cells under different growth conditions. AVoltage-sensitive FRET (fluorescent energy transfer) probe was used forpotentiometric ratio measurements. It has two fluorescent components:CC₂-DMPE (Coumarin) and DISBAC₂(3) (Oxonol). The oxonol distributesitself on opposite sides of the cell membrane in a Nernstian manneraccording to the Ψ. The voltage sensitive distribution of oxonol istransduced through a ratiometric fluorescence signal via the coumarinwhich is bound to the outside surface of the cell membrane therebyamplifying the fluorescence. Measurements were made using a fluorescencemicroscope and a digital imaging system. The ratio measurements arecalibrated using Gramicidin D to depolarize the cell membrane and thenvarying the external K⁺-concentration. The calibrated cell membranepotential in mV is depicted on the y-axis.

The filled bars indicates the Ψ of exponentially growing prostaticepithelial cells before they reach confluence, whereas the open barsdepict the Ψ of the cells once they reach confluence and cell growthslows. The first two bars demonstrate that prostatic epithelial cellsare depolarized when rapidly growing and hyperpolarize by about 20 mVwhen they reach confluence. The second pair of bars demonstrate thatexponentially growing cells are depolarized even in growth factordeprived culture conditions (stripped serum) and hyperpolarize less inthe absence of growth factors on reaching confluence. The final pair ofbars demonstrate that cells grown in the presence of the activemetabolite of testosterone, DHT (dihydroxytestosterone), are slightlyhyperpolarized during exponential growth, but depolarize on reachingconfluence.

These differences in cell membrane potential support the notion thatgrowth conditions of prostatic epithelia in vivo will likely influencethe cell membrane potential of prostatic epithelial cells. Cell membranepotential will influence the transepithelial potential measured at theprostate surface. Alteration in the DC potential measured trans-rectallyin combination with impedance will be used to diagnose prostate cancer.

FIG. 14 demonstrates electropotential measurement made over the prostateof a patient with a normal prostate. The patient was undergoing acolonoscopy for screening, which was negative and had a normal PSA. TheECM (electroconductive medium) contained 5 mM K⁺ and physiologicalconcentrations of other electrolytes. The filled circles and solid linerepresent the measurement of surface electropotential (y-axis) startingat 1 cm from the anal verge to 8 cm along the anterior aspect of therectum (x-axis). The values increase from approximately −28 mV to −70 mVover the prostate and drop (depolarize) to approximately −52 mV over thetop of the prostate, and referenced to the bloodstream. When the ECM ischanged to a solution with the same osmolality, but with a K⁺concentration of 30 mM. The electropotential of the surface of therectal mucosa depolarizes to 30 mV (open circles joined by a dottedline). This indicates significant K⁺ permeability of the overlyingrectal mucosa. The higher region of electro-negativity over the prostateis consistently seen when the prostate is healthy.

FIG. 15 demonstrates measurement made in a patient with a previouslybiopsied prostate cancer. The symbols and axes are the same as in FIG.14. The region of electro-negativity is lower over the cancerousprostate. In this case electropotential measurements of between −26 and−27 mV were made over the cancerous lobe of the prostate i.e., 30 to 40mV lower than observed over healthy prostate. When the ECM was changedto a solution with a K⁺-concentration of 30 mM a depolarization of 8-9mV was observed, or about a third of that observed in healthy prostate.This indicates a decrease in K⁺-conductance and permeability of both theprostate and overlying rectal mucosa.

These changes in the normal DC electrical profile of the prostate willbe used separately or in combination with AC impedance measurements todiagnose prostate cancer. Identification of depolarization of theprostate relative to the higher polarity of the surrounding rectalmucosa together with decreased K⁺-conductance indicate the presence ofprostate cancer. Additional AC measurements with differently spacedelectrodes will permit probing of the underlying prostate to accuratelylocalize the site of the prostatic malignancy.

EXAMPLE 5 Chemopreventative and Therapeutic Use

In addition to the ionic, pharmacologic, and hormonal agents describedabove, the system and method of the present invention may be used withcancer preventative and therapeutic agents and treatments. Specifically,electrical measurement of altered structure and function provides amethod for evaluating a patient's response to the drugs withoutrequiring a biopsy and without waiting for the cancer to furtherdevelop. Patients who respond to a given chemopreventative ortherapeutic agent would likely show restoration of epithelial functionto a more normal state. Patients who do not respond would show minimalchange or may even demonstrate progression to a more advanced stage ofthe disease. This system and method, thus, may be used by eitherclinicians or drug companies in assessing drug response or by cliniciansin monitoring the progress of a patient's disease and treatment, ormonitoring the process of carcinogenesis (cancer development), before anovert malignancy has fully developed.

Furthermore an understanding of the physiological basis of the alteredimpedance permits more accurate diagnosis. For example impedance mayincrease or decrease because of several factors. Increased stromaldensity of breast tissue may alter impedance. This is a non-specificchange, which may not have any bearing on the probability of malignancy.On the other hand a decrease in potassium permeability of the epitheliaaround a developing malignancy would increase impedance and would bemore likely associated with a developing cancer than a non-specificimpedance change. Additional information is obtained from my method byprobing the tissue to different depths using spaced voltage-sensingelectrodes. The use of electrophysiological, pharmacological andhormonal manipulations to alter impedance differentially in normalcompared to cancer-prone, pre-malignant or malignant tissue is anothersignificant difference, which enhances the diagnostic accuracy of myinvention over the above referenced one.

Further improvements to the methods described above have been made bythe inventor herein as disclosed in continuation-in-part patentapplications Ser. No. 10/716,789, published as U.S. 2004/0253652(entitled “Electrophysiological Approaches to Assess Resection and TumorAblation margins and Responses to Drug Therapy”) and Ser. No.10/717,074, published as U.S. 2004/0152997 (entitled “Method and Systemfor Detecting Electrophysiological Changes in Pre-cancerous andCancerous Breast Tissue and Epithelium”), each filed Nov. 19, 2003; andProvisional Application No. 60/673,448, filed Apr. 21, 2005, entitled“Method and System for Detecting Electrophysiological Changes inPre-Cancerous and Cancerous Tissue and Epithelium;” the disclosures ofeach of these patents and applications are hereby incorporated herein intheir entirety.

U.S. 2004/0253652 discloses a method and system for determining acondition of a selected region of epithelial and stromal tissue in thehuman breast. A plurality of measuring electrodes are used to measurethe tissue and transepithelial electropotential of breast tissue.Surface electropotential and impedance are also measured at one or morelocations. An agent may be introduced into the region of tissue toenhance electrophysiological characteristics. The condition of thetissue is determined based on the electropotential and impedance profileat different depths of the epithelium, stroma, tissue, or organ,together with an estimate of the functional changes in the epitheliumdue to altered ion transport and electrophysiological properties of thetissue. Devices for practicing the disclosed methods are also provided.For example, the invention includes an apparatus for determining thecondition of a region of tissue comprising: a cup having an interior,and first and second openings; an electrode disposed within theinterior; and a source of suction connectable to the first opening; andwherein the second opening is placed over a region of tissue and suctionis applied to the first opening and an electrical connection is madebetween the region of tissue to be examined and the electrode.Furthermore, the invention provides for methods for determining acondition of a region of epithelial breast tissue or the location of atumor in an organ, for example, the breast, comprising: establishing aconnection between a first electrode and the epithelial tissue of abreast; placing a second electrode in contact with the surface of thebreast; establishing a signal between the first and second electrodes;measuring at least one. electrical property between the first and secondelectrode; and determining the condition of a region of epithelialtissue or the location of a tumor based on the signal between the firstand second electrode. A plurality of electrical properties can bemeasured including, for example, impedance measured at at least twodifferent frequencies.

U.S. 2004/0152997 discloses a method and system for determining acondition of a selected region of tissue to facilitate the location ofsurgical resection margins. Electropotential and impedance are measuredat one or more locations in an area of the body where tissue is to beremoved. An agent may be introduced into the region of tissue to enhanceelectrophysiological characteristics of that tissue. The condition ofthe tissue is measured by electropotential and impedance profile.Differences in the profile are used to determine the borders betweennormal and abnormal tissue so as to facilitate what tissue to resect.Methods and apparatus are also disclosed to determine the efficacy ofvarious therapies.

Provisional application U.S. 60/673,448 discloses a method and systemfor determining a condition of a selected region of epithelial andstromal tissue, and in various organs including, for example, prostate,colon, breast, esophagous, and nasopharyngeal tissue, as well as organsand other tissues that exhibit epithelial malignancies, such as lung,gastric, uterine cervix, endometrial, skin and bladder; the methods andsystem are particularly applicable to the human breast. A plurality ofelectrodes are used to measure surface and transepithelialelectropotential of breast tissue as well as surface electropotentialand impedance at one or more locations and at several definedfrequencies, particularly very low frequencies. An agent may beintroduced into the region of tissue to enhance electrophysiologicalcharacteristics. Measurements made at ambient and varying suctionconditions applied to the epithelial tissue are also used as adiagnostic tool. Tissue condition is determined based on theelectropotential and impedance profile at different depths of theepithelium, stroma, tissue, or organ, together with an estimate of thefunctional changes in the epithelium due to altered ion transport andelectrophysiological properties of the tissue. Devices for practicingthe disclosed methods are also provided. For example, the disclosureteaches a method for determining a condition of a region of epithelialbreast tissue comprising: (A) establishing a connection between a firstelectrode and the epithelial tissue of the nipple of a breast with aductal probe, an electroconductive media or both; (B) placing a secondelectrode in contact with the surface of the breast; (C) establishing asignal between the first and second electrodes; (D) establishing thatthe nipple ducts of the breast are open by: (1) measuring the impedancebetween the first and second electrode at about 5 different frequenciesin the range of about 200 Hz to about 60,000 Hz sufficient to establishan impedance curve; (2) treating the nipple using at least one methodselected from the group consisting of (a.) applying suction and releaseof suction to the nipple; (b) applying alcohol; and (c) applying adekeratinizing agent; (3) again measuring the impedance between thefirst and second electrode at about 5 different frequencies in the rangeof about 200 Hz to about 60,000 Hz sufficient to establish an impedancecurve and comparing the impedance curve obtained to that obtained in(D)(1) above; (4) repeating steps (2) and (3) until the impedance curveobtained in step (D)(3) is substantially unchanged in order to confirmthat the ducts are open; (E) measuring between the first and secondelectrode: (1) a DC potential; and (2) impedance at about 5 differentfrequencies in the range of about 10 Hz to about 200 Hz and impedance atfrom about 5 to about 50 different frequencies in the range of about 0.1Hz to about 10 Hz; and (F) determining the condition of the region ofepithelial tissue based on the DC potential and impedance measurementsbetween the first and second electrode. Alternatively it discloses amethod for determining a condition of a region of epithelial breasttissue comprising: (A) placing over the nipple of a breast a cup havingan interior, and first and second openings, and an electrode disposedwithin the interior, the cup having a source of suction in communicationwith the first opening, the second opening having been placed over thenipple; (B) establishing a connection between the electrode and theepithelial tissue of the nipple of a breast with a ductal probe, anelectroconductive media or both; (C) placing a second electrode incontact with the surface of the breast; (D) establishing a signalbetween the first and second electrodes; (E) establishing that thenipple ducts of the breast are open by: (1) measuring the impedancebetween the first and second electrode at about 5 different frequenciesin the range of about 200 Hz to about 60,000 Hz sufficient to establishan impedance curve; (2) treating the nipple using at least one methodselected from the group consisting of (a) applying suction and releaseof suction to the nipple; (b) applying alcohol; and (c) applying adekeratinizing agent; (3) again measuring the impedance between thefirst and second electrode at about 5 different frequencies in the rangeof about 200 Hz to about 60,000 Hz sufficient to establish an impedancecurve and comparing the impedance curve obtained to that obtained in(D)(1) above; (4) repeating steps (2) and (3) until the impedance curveobtained in step (E)(3) is substantially unchanged in order to confirmthat the ducts are open; (F) measuring a DC potential between the firstand second electrode; (G) applying suction to the cup sufficient toeffect ductal collapse in a normal or non-malignant duct; and measuringimpedance at about 5 different frequencies in the range of about 10 Hzto about 200 Hz and impedance at from about 5 to about 50 differentfrequencies in the range of about 0.1 Hz to about 10 Hz; and (H)altering the suction level and again measuring impedance at about 5different frequencies in the range of about 10 Hz to about 200 Hz andimpedance at from about 5 to about 50 different frequencies in the rangeof about 0.1 Hz to about 10 Hz; and (J) determining the condition of theregion of epithelial tissue based on the DC potential, and the impedancemeasurements under varying pressure conditions.

In contrast to the methods and equipment described in detail above,methods and equipment also have been developed for measuring electricalproperties, especially impedance, “through the breast.” This technologyis disclosed, for example, in the following patents, each of which isincorporated herein in their entirety: U.S. Pat. No. 4,291,708, issuedSep. 29, 1981 (E. H. Frei et al., “Apparatus and-Method for Detection ofTumors in Tissue”); U.S. Pat. No. 4,458,694, issued Jul. 10, 1984 (B. D.Sollish et al., “Apparatus and Method for Detection of Tumors inTissue”); U.S. Pat. No. 4,486,835, issued Dec. 4, 1984 (D. Bai et al.,“Apparatus and Techniques for Electric Tomography”); U.S. Pat. No.5,143,079, issued Sep. 1, 1992 (E. Frei et al., “Apparatus for Detectionof Tumors in Tissue”).

The technology disclosed in U.S. Pat. No. 4,291,708 includes both anapparatus and method for detecting tumors in living human breast tissue.The apparatus includes instrumentalities for determining the dielectricconstants of a plurality of localized regions of living human breasttissue and include a bridge which is provided with a circuit thatallows, if desired, for automatically nulling the bridge while inoperation as well as applying a swept frequency signal. Suchinstrumentalities are capable of measuring variations in the dielectricconstants over a plurality of the regions and for indicating thepossible presence of a tumor as result of the measurement. The apparatusmay be utilized in carrying out a method of detecting tumors whichincludes the steps of applying a plurality of probe elements to humanbreast tissue for sensing characteristics of localized regions thereof,selectively applying an electrical signal to the probe elements fordetermining dielectric constants of localized regions of the tissue,sensing variations in the dielectric constants and determining therate-of-change of dielectric constant at each of the localized regions.

U.S. Pat. No. 4,458,694 discloses an apparatus for detecting tumors inliving human breast tissue comprising apparatus for determining thedielectric constants of localized regions of living human breast tissueincluding probe apparatus comprising a multiplicity of probe elements,apparatus for applying an AC signal to the tissue, apparatus for sensingelectrical properties at each of the probe elements at a plurality ofdifferent times, and signal processing circuitry, coupled to the sensingapparatus for comparing the electrical properties sensed at theplurality of different times for providing an output indication of thedielectric constant of the localized region of breast tissue associatedwith the probe apparatus. The apparatus includes means to apply a sweptfrequency signal and measure a plurality of AC signals as well asautomatic switching means to selectively and sequentially measure ACsignals at individual probe elements.

U.S. Pat. No. 4,486,835 discloses an apparatus for electric tomographycomprising a coupling medium for receiving an object to be examined, aplurality of electrodes disposed in the coupling medium and arranged ina three dimensional array; multiplexing apparatus for applying electricvoltages at selected first pluralities of electrodes and simultaneouslymeasuring electric currents at corresponding selected second pluralitiesof electrodes in a desired sequence; and computation apparatus coupledto the multiplexing apparatus for initially estimating the values ofelectrical properties at a multiplicity of locations in the object to beexamined, these locations being arranged in a three dimensionalimaginary grid defined in the object to be examined and subsequentlycorrecting the initially estimated values of the electrical propertiesat each of the multiplicity of locations on the basis of the measuredcurrents by an iterative process using an inverse Laplace equation. Theapparatus also includes means for providing a visual tomographicrepresentation of the values of the electrical properties at eachlocation. The electrodes can be arranged in various patterns andselectively energized in various combinations or sequences.

U.S. Pat. No. 5,143,079 discloses improvements in apparatus fordetecting tumors in living human breast tissue of the type describedabove comprising means for determining the dielectric constants oflocalized regions of living humans breast tissue including amultiplicity of planar hexagonal probe elements in a closely spacedgeometric pattern.

It has now been found that when current is passed across a malignanttumor from another site on the breast or body, rather than from thenipple to the surface of the breast, the impedance may be lower when thevoltage drop is measured across the tumor rather than between the nippleand the tumor i.e., across ductal epithelium. The capacitance is usuallyhigher when the measurement is made across a malignant tumor, ratherthan across the ductal epithelium. Therefore a combination ofmeasurements; nipple to breast surface (transepithelial impedancespectroscopy), body surface to breast surface (transtumor impedance),and transepithelial potential (ductal epithelium in series with skin canprovide enhanced diagnostic information. This is demonstrated in theexperiments represented by FIGS. 16-20.

FIG. 16 illustrates measurement made in a woman with an early stagecarcinoma of the left breast. Nyquist plots are shown where theimpedance was measured at 59 logarithmically placed frequencies between60,000 Hz and 0.1 Hz. (LOQ=lower outer quadrant, UOQ=upper outerquadrant, UIQ=upper inner quadrant). The patient was prepped using analcohol wipe to the skin of the breast and NuPrep to remove keratinplugs from the nipple. The black symbols show data from the controlquadrants (lower inner quadrant data is not shown to avoid cluttering ofthe graph and is similar to the data from the other two controlquadrants). The open circles demonstrate measurement data obtained overthe carcinoma in the upper inner quadrant of the left breast. It isevident from the graph that there is a double hump in the Nyquist plotsobtained from the control quadrants. This indicates at least tworesistance-capacitance (RC) circuits with different time constants whichmanifests itself as a double-hump on the Nyquist plots (i.e., twoseparate semicircles). The Nyquist plot from over the tumor demonstratesone inverted semicircle indicating that the low frequency RC circuit hasa similar time constant as the higher frequency circuit (i.e., the twosemicircles fuse into one). This indicates that the more conductivetumor impedance dominates the higher impedance of the ductal epithelium.It is noted that most if not all of the published literature and patentshave shown that carcinomas have a high conductance whereastransepithelial data demonstrates a low conductance (high impedance) ofthe ductal epithelium when measurements are made across the epithelium.Measurement through the breast shows high conductance when a largertumor is present, presumably because the epithelium is not being“interrogated,” i.e., it is not believed to be the path for the currentwhen current is passed through the breast.

In this case the low impedance at low measurement frequencies might leadto a false negative interpretation. Smaller lesions, particularlyintraductal carcinomas, typically exhibit a higher impedance at lowfrequencies. In this case because of the high conductance of thesurrounding tumor there is obersved a lower impedance in the lowfrequency range with the high conductivity of the tumor dominating theimpedance spectrum of the ductal epithelium from which the tumororiginated. In this case the correct diagnosis can be made because thetumor is 14 mV depolarized compared to measurements taken over thecontrol quadrants (73 Vs 87 mV).

Additional information can be obtained by making through the breastmeasurements using only surface electrodes (i.e., without measuringthrough the nipple cup electrode which provides access to the ductalepithelium). FIG. 17 illustrates such measurements obtained in the samewoman described in FIG. 16. The figure demonstrates through-the-breastimpedance (i.e., the impedance from one uninvolved quadrant to anotheruninvolved quadrant. In this case from the upper outer quadrant to thelower inner breast quadrant—control quadrants), and through-the-tumorimpedance measurements (i.e., from the upper inner quadrant containingthe tumor to the lower outer quadrant—the other control uninvolvedquadrant). It can be seen that the arc for the Nyquist plot is muchtighter in the through the tumor measurements than the arc measuring theimpedance through the breast for the uninvolved quadrants (i.e., theradius of the imaginary semicircle is less for the through the tumorcompared with the through the breast measurements in the frequency range75 to 6 Hz. The arrows depict the direction of the changing impedancewith decreasing frequency. This indicates that the impedance through thetumor is close to 0 (since the Nyquist plot semicircle does notintersect the x-axis) and is estimated at 386 Q through the uninvolvedquadrants of the breast at these low frequencies. Taken together thetransepithelial and through-the-breast measurements provide greaterdiagnostic information than either method by themselves.

In the next example illustrated in FIG. 18, Nyquist plots are based ondata obtained from measurements on a 45 year-old woman with a 1.3 cmcarcinoma of the breast. Without through-the-breast measurements,diagnostic interpretation of the results may be difficult. Even thoughthe resistance measured over the tumor containing quadrant of the breastis high at approximately 1.40 million ohms at very low frequencies, theimpedance of the three control quadrants varies between 1.22 and 1.29million ohms. Therefore the transepithelial resistance was only between9 and 15% higher in the cancer containing region of the breast comparedwith the control quadrants. When the through-the-breast impedance wasmeasured in the control quadrants a value of 132 ohms was obtained,compared with 60 ohms in the intermediate to high frequency range (6 to60,000 Hz) in the cancer bearing quadrant of the breast. In this casealthough the transepithelial impedance was higher in the cancercontaining quadrant, the other control quadrants had similar, althoughnot quite as high, transepithelial impedance. Measurement ofthe-through-the breast impedance demonstrated an impedance that wasapproximately 55% lower in the cancer containing quadrant of the breastthus establishing the diagnosis when making the two different types ofmeasurements, transepithelial and surface through-the-breast.

FIG. 19 illustrates how a combination of measurement may be used toreduce a false positive diagnosis of carcinoma of the breast. The datain FIG. 19 were obtained from a perimenopausal 50 year-old woman withfibrocystic changes in the breast. Transepithelial measurements madebetween a nipple cup sensor and Quadrant A (upper outer quadrant rightbreast) demonstrate high impedance with a Nyquist plot indicating aresistance of more than 80,000 ohms at low frequencies (inverted opentriangles). The other 3 quadrants of the breast (open symbols) showNyquist plots of transepithelial impedance in the upper left hand cornerof the figure with the highest impedance reaching only 19,000 ohms atvery low frequencies (0.1 Hz). The open circuit potential of quadrant Awas −66 mV whereas the mean open circuit potential of the other threecontrol quadrants measured −65 mV, which was not significantlydifferent. The high resistance of quadrant A is suggestive ofmalignancy. In contrast, the similar open circuit potential betweenquadrant A and quadrants B, C and D suggest a benign condition. Thethrough-the-breast impedance measured between quadrants A and C (upperouter and lower inner breast quadrants) is depicted by the filled blackcircles and shows resistance measurements of 73,000 ohms at lowfrequencies. This is significantly greater than the through-the-breastimpedance measurement from quadrant B to D (upper inner to lower outerbreast quadrants), best seen in FIG. 20, which is a higher scalemagnification of the upper left hand corner of FIG. 19.

In FIG. 20 the filled black squares in the upper left corner show thethrough the breast impedance from breast quadrant B to D. The resistanceat 0.1 Hz measures just over 6700 ohms, which is less than 10% of theimpedance measured through-the-breast from quadrant A to C. In this casethe through-the-breast measurement in combination with the open circuit:potential and transepithelial measurement permit the correct diagnosisof benign disease, because the high quadrant A impedance originatesoutside the breast epithelium.

All documents described herein are incorporated by reference herein,including any patent applications and/or testing procedures. Otherembodiments of the invention will be apparent to those skilled in theart from consideration of the specification and practice of theinvention disclosed herein. It is intended that the specification andexamples be considered as exemplary only, with a true scope and spiritof the invention being indicated by the following claims.

1. A method for determining a condition of a region of organ or mucosalepithelial tissue comprising: (A) placing at least two current-passingelectrodes in contact with or in proximity to a surface of the selectedregion of tissue; (B) placing a plurality of measuring electrodes incontact with or in proximity to the surface of the selected region oftissue; (C) establishing an electrical signal between thecurrent-passing electrodes; (D) measuring, at one or more of themeasuring electrodes, an electrical measurement associated with theestablished signal; (E) introducing at least one agent into the selectedregion of tissue while electrically probing said tissue, said agentcomprising one or more pharmacological agent, hormone, chemical compoundor mixture thereof, added to an electroconductive medium (ECM) orotherwise introduced to the tissue, which modulates, inhibits orstimulates electrical activity of said tissue and selected todifferentially alter, reveal and accentuate electrophysiologicalcharacteristics indicative of abnormal or cancerous tissue compared tobenign tissue; (F) measuring, at one or more of the measuringelectrodes, an electrical measurement associated with the establishedsignal while introducing the at least one agent; and (G) applying atleast one probe comprising a plurality of probe elements to said tissuesuch that individual ones of the probe elements are arranged for sensingor measuring characteristics of individual localized regions of the saidtissue; (H) selectively applying an electrical signal to the probeelements for determining the dielectric constants of the localizedregions of said tissue; and (1) determining the condition of theselected region of tissue based on the electrical measurement, followingthe introduction of the at least one agent; or (2) detecting a possibletumor by sensing or measuring variations in the dielectric constantsover a plurality of the regions; or both (1) and (2); and furthercomprising the step of determining the rate of change of dielectricconstant with frequency or log of frequency at each of the localizedregions.
 2. A method for determining a condition of a region of organ ormucosal epithelial tissue comprising: (A) placing at least onecurrent-passing electrode in contact with or in proximity to a surfaceof the selected region of tissue; (B) placing a plurality of measuringelectrodes in contact with or in proximity to the surface of theselected region of tissue; (C) establishing an electrical signal betweenat least one current-passing electrode and at least one of the measuringelectrodes; (D) measuring, at one or more of the measuring electrodes,an electrical measurement associated with the established signal; (E)introducing at least one agent into the selected region of tissue whileelectrically probing said tissue, said agent comprising one or morepharmacological agent, hormone, chemical compound or mixture thereof,added to an electroconductive medium (ECM) or otherwise introduced tothe tissue, which modulates, inhibits or stimulates electrical activityof said tissue and selected to differentially alter, reveal andaccentuate electrophysiological characteristics indicative of abnormalor cancerous tissue compared to benign tissue; (F) measuring, at one ormore of the measuring electrodes, an electrical measurement associatedwith the established signal while introducing the at least one agent;and (G) applying at least one probe comprising a plurality of probeelements to said tissue such that individual ones of the probe elementsare arranged for sensing or measuring characteristics of individuallocalized regions of said tissue; (H) selectively applying an electricalsignal to the probe elements for determining the dielectric constants ofthe localized regions of said tissue; and (1) determining the conditionof the selected region of tissue based on the electrical measurement,following the introduction of at least one agent; or (2) detecting apossible tumor by sensing or measuring variations in the dielectricconstants over a plurality of the regions; or both (1) and (2); andfurther comprising the step of determining the rate of change ofdielectric constant with frequency or log of frequency at each of thelocalized regions.
 3. A method for determining a condition of a regionof organ or mucosal epithelial tissue comprising: (A) placing at leastone current-passing electrode in contact with or in proximity to asurface of the selected region of tissue; (B) placing a plurality ofmeasuring electrodes in contact with or in proximity to the surface ofthe selected region of tissue; (C) establishing an electrical signalbetween at least one current-passing electrode and at least one of themeasuring electrodes; (D) measuring, at one or more of the measuringelectrodes, an electrical measurement associated with the establishedsignal; (E) applying at least one probe comprising a plurality of probeelements to said tissue such that individual ones of the probe elementsare arranged for sensing or measuring characteristics of individuallocalized regions of said tissue; (F) selectively applying an electricalsignal to the probe elements for: (1) determining the dielectricconstants of the localized or selected regions of said tissue; and (2)measuring the impedance of the localized or selected regions of tissue;and (G) detecting the presence of a possible tumor by sensing ormeasuring variations in the dielectric constants and impedance over saidregions.
 4. The method of claim 3, wherein placing of the at least onecurrent-passing electrode or measuring electrodes includes the step ofplacing a probe in contact with or in proximity to the surface of theselected region of tissue, wherein the at least one current-passingelectrode is situated on the probe.
 5. The method of claim 3, whereinthe step of determining the condition of the selected region of tissueincludes rating the tissue as normal, at-risk, pre-cancerous, orcancerous.
 6. The method of claim 3 wherein said electrical signal is ata frequency of about 0.2 Hz to about 6000 Hz.
 7. A method fordetermining a condition of a region of organ or mucosal epithelialtissue comprising: (A) placing at least two current-passing electrodesin contact with or in proximity to a surface of the selected region oftissue; (B) placing a plurality of measuring electrodes in contact withor in proximity to the surface of the selected region of tissue; (C)establishing an electrical signal between the current-passingelectrodes; (D) measuring, at one or more of the measuring electrodes,an electrical measurement associated with the established signal; (E)introducing at least one agent into the selected region of tissue whileelectrically probing said tissue, said agent comprising one or morepharmacological agent, hormone, chemical compound or mixture thereof,added to an electroconductive medium (ECM) or otherwise introduced tothe tissue, which modulates, inhibits or stimulates electrical activityof said tissue and selected to differentially alter, reveal andaccentuate electrophysiological characteristics indicative of abnormalor cancerous tissue compared to benign tissue; (F) measuring, at one ormore of the measuring electrodes, an electrical measurement associatedwith the established signal while introducing the at least one agent;and (G) applying at least one probe comprising a plurality of probeelements to said tissue such that individual ones of the probe elementsare arranged for sensing or measuring characteristics of individuallocalized regions of the said tissue; (H) selectively applying anelectrical signal to the probe elements for determining the dielectricconstants of the localized regions of said tissue; and (1) determiningthe condition of the selected region of tissue based on the electricalmeasurement, following the introduction of the at least one agent; or(2) detecting a possible tumor by sensing or measuring variations in thedielectric constants over a plurality of the regions; or both (1) and(2); wherein said electrical signal is at a frequency of about 0.2 Hz toabout 6000 Hz.
 8. A method for determining a condition of a region oforgan or mucosal epithelial tissue comprising: (A) placing at least onecurrent-passing electrode in contact with or in proximity to a surfaceof the selected region of tissue; (B) placing a plurality of measuringelectrodes in contact with or in proximity to the surface of theselected region of tissue; (C) establishing an electrical signal betweenat least one current-passing electrode and at least one of the measuringelectrodes; (D) measuring, at one or more of the measuring electrodes,an electrical measurement associated with the established signal; (E)introducing at least one agent into the selected region of tissue whileelectrically probing said tissue, said agent comprising one or morepharmacological agent, hormone, chemical compound or mixture thereof,added to an electroconductive medium (ECM) or otherwise introduced tothe tissue, which modulates, inhibits or stimulates electrical activityof said tissue and selected to differentially alter, reveal andaccentuate electrophysiological characteristics indicative of abnormalor cancerous tissue compared to benign tissue; (F) measuring, at one ormore of the measuring electrodes, an electrical measurement associatedwith the established signal while introducing the at least one agent;and (G) applying at least one probe comprising a plurality of probeelements to said tissue such that individual ones of the probe elementsare arranged for sensing or measuring characteristics of individuallocalized regions of said tissue; (H) selectively applying an electricalsignal to the probe elements for determining the dielectric constants ofthe localized regions of said tissue; and (1) determining the conditionof the selected region of tissue based on the electrical measurement,following the introduction of at least one agent; or (2) detecting apossible tumor by sensing or measuring variations in the dielectricconstants over a plurality of the regions; or both (1) and (2); whereinsaid electrical signal is at a frequency of about 0.2 Hz to about 6000Hz.